 It's fantastic the new pills are which are coming onto the market, they are not silver bullets really. So next slide please. The anti-viral drugs, you know, we talked in the past about the vaccinations and now we talk about drugs and we need all of that, we need the vaccines but we need also therapeutics to treat patients who are sick. When you see the 80 antivirals available, about 80 are available for treating viral infection and 50% of them are treat HIV. So because that's the most important, HIV needs daily treatment of at least three different antivirals from two different categories which is a good business for the pharmaceutical industry. Everything what needs a daily treatment is something good and therefore you see there are many more HIV antivirals as there are an example for herpes where you treat maximum a week. And now from now onwards we have a new group of antivirals, these are the one against COVID. So the next slide please. You see very important for the future it is to clarify in what stage patients are because some of these pharmaceuticals are working only in the early stage, some others work only in the very late stage and there is this very nice description which shows you that there is non-severe disease, there's absence of science of severe or critical disease but there's a positive test result. And then we are in the severe area where oxygen torps down under 90%, there's signs of pneumonia, signs of severe respiratory disease and then you become in the critical stage where you have requires life-sustaining treatment, acute respiratory distress syndrome, sepsis, septic shock. So for all the things that needs different treatments and the antivirals are used in a different way and that should be checked first. Next slide. And you see there is an emerging use asaurization in place for all the vaccines and therapeutics because it takes much longer to get a proper market asaurization for the project. So there's this wonder track, Ivermectin. You know, in my first period at the pharmaceutical industry I was part of the clinical research team of Ivermectin which is an animal health product and got the first market asaurization in 1981 and it's for livestock as well as for companion animals and there are various formulations on the market. It came up as a Ivermectin mainly from Australia where it showed some efficacy in trials, in lab trials but not in human beings. And now it's still a hype going on. It's incredible what this discussions on the social media about Ivermectin and how it helps and it has to do that even Donald Trump at this time got Ivermectin, all the others which you see here as he was treated actually is everything a good patients or a guinea pig for trials. So Ivermectin actually, as I said, was for animal health approved in 1981. Then it started to be used in human beings and it was mainly because horses have a parasite which is the onchotercosis and it's similar to the river blind as a disease which we have in Africa and some Asian and South American countries. And we realized that Ivermectin is really cleaning up this in very many, many areas of Africa and South America river blindness is disappeared because of Ivermectin is an oral treatment. And if you come to the WHO, you see a big statue there and old man who is blind and it was there because Merck was at this time donating all these drugs they have developed under the name Mectison to the WHO and they were doing the treatment. So there was no commercial activity in this area. Then Ivermectin came out of patent and now there are many generic Ivermectins on the market. Some tablets are still in use for headlights in kits and for some parasitic diseases in humans but they're all disappeared because everybody buys everything what he can get. Now people start to use the animal formulations and quite a number of people died already because the dosage you have to have a high dosage and this high dosage is very toxic. So finally it became very famous because in Japanese guy and Campbell from US got in 2015 the Nobel Prize for Ivermectin use in human beings for the river blindness. And the interesting thing is the soil sample was found on the golf course and that's why it's important Michael Victor that you play with me on Sunday or maybe if I find another soil sample and it was fantastic because it was really effective against the endoparasites and the exoparasites. Another is the hydroxychloroquine but you see Ivermectin is there's a warning for use. The same is for hydroxychloroquine. This is the oldest malaria treatment and prophylactic use. Even that is not recommended to use and there's dexamethasone with an NSID. This is a non structural corticosteroids a non corticosteroid drug for inflammation. This is used mainly in severely diseased people because in severely diseased people not the virus is the problem. It's just a reaction of the patient to the virus. And this is an over reaction of the inflammation system and dexamethasone can reduce this inflammation. Next. So then there was a group of monoclonal antibodies until yesterday. There were the only antivirals which could be used for COVID-19 and then mimic the natural antibodies needed to fight COVID-19 and they target the epitopes on South coast by spike protein therefore blocking the virus from entering the cells. And they are only recommended for early treatment in high risk unvaccinated people or people who may not mount or react on a vaccination properly. And they can reduce the severe illness when given this in five to seven days of symptoms onset. And so there's this small window where you can use it but they react very quickly and build up a passive immunity but only for a short period. Now studies are on the way to make long-acting monoclonal antibodies. The other negative thing is it needs to be an intravenous administration. Difficult to produce, difficult to supply and price issue, they are very expensive. The next, and this is Remdesivier was the only officially product which had an emergency use acceptance approval. It was developed to treat hepatitis C and Ebola and was really accelerating recovering about people which are hospitalized with COVID-19 but the effect is that in average it's only four days shorter people are in the hospital. So it's not a real big effect and it's very expensive. The one course of treatment which is six days treatment cost in US between $2,000 and $3,000 and this is certainly difficult to have a product with that on the market but Remdesivier allowed some generic companies to produce it and there's some companies produces for low and middle income countries for about $600. Again, intravenous treatment which needs a hospital situation to be able to use it. The next, so now these are the new antivirals, Molnur Piravir from Merck and Paxelwied from Pfizer. Paxelwied is the trade name that's why it's in capital letters. They just were all reporting first results in November this year and the results are so successful that the clinical trials were stopped and they are both now in the process to get an emergency use authorization for treatment. So but again, only for people in the early stage in their illness and they were only looking at the do you die or do more die or more be hospitalized against placebo groups. None of the studies is peer-reviewed so all the information we have is just straight information from the two companies and can cut hospitalization in days when people are treated soon after infection and this is a bottleneck. No patient who took either drug diet in the studies hospitalized patient do not recover faster from COVID-19 if they get these two drugs. But as I said before, in a hospitalized situation the virus is not the problem, it's just only the reaction to the virus. And the most important thing is both can be taken as a pill so it's a oral treatment can be treated people can treat it themselves as home and it's relatively cheap to manufacture US has already 6.5 billion dollar bought from the two companies this product so I think it takes again as it was with the vaccine a long time until we see this pharmaceuticals in the low and middle income countries. Next slide. So a little bit more to Molnupiravir, the trade name is Lagiviro and it's from Merck but this is a product which came actually from Richbeck Biotherapeutics. They have already an emergency use of psoriation from UK and is so far the first one business authorization oral for sure and it reduced the risk of cancer hospitalization by about 50% in non-hospitalized adult patients with mild to moderate COVID-19 when treated within five days of symptoms onset. It needs a treatment twice a day for five days and treatment is disrupting the life cycle of the virus and preventing the virus from replicating. And this is a little for this product a little bit difficult because it's a lot of mutations which are produced within the virus. And so everybody expects is working nicely against all variants which are in the market maybe even the new one in South Africa but people say if it's actually triggers mutations maybe that could be fireback and we have a new mutant which comes up from a pharmaceutical product. So there is the European Medicine Agency which will most likely end of November approve the product for emergency use once from using in pregnancy and using women who plan to get pregnant. Next slide. And this is Paxlobe. This is a Pfizer product and this is a much better effectiveness. You see 89% of people the risk was reduced by 89% for hospitalization or deaths. And this is in the example only open 8% of the treated patients who are coming into hospital and only versus 7% from the placebo treated not a single that person in the treated group there were a couple of there were 10 people in the placebo group. So it is should be used in three days if we use it in five days after the onset of the symptom the effectiveness is lower already. The oral treatment every 12 hours for five days they have submitted to the FDA and it works with a specific designed protease inhibitor and protease is needed for the virus to replicate. In addition, they have to give return of here. This is an antiviral product which is used in particular for HIV and this is given because it slows down the metabolism of the medicament and gives a better pharmacokinetic level. Retona, the WHO recently said return of here should not be used for COVID-19, it has no effectiveness but that's not why it's used here. It's just used to support the other protease inhibitor which is the main treatment active principle. An interesting aspect is and you see the first I said this is a Pfizer press release from 5th of November because they're also speculating it doesn't reduce the probability of infection following exposure. So if you get the information that one of your contacts have been positive you could immediately start to use these products and make sure that you are even in case you are infected you are not hospitalized or will die. So they have tested in vitro the most variants of concerns which are currently circulating certainly not the very new one. And in vitro it shows that the variants of concern are controlled by this product as well. And they believe that it will have an effect in many other coronaviruses which is a long hoped target. You know that we have not just a pharmaceutical for one coronavirus but for many others as well. And interesting is the equitable access for all people. They have a tired pricing approach. So you pay a high price in a developed country and a low price in a non-developed country. And they aren't currently in the way trying to find contract manufacturer who may produce it in a cheaper way as Pfizer can do it. They are now already talking to 59 countries where they have purchased agreements in place. But as I said, 100 million doses are already of this product going to the US. And they are investing one billion to support manufacturing and distribution particular in the third in the developing world. The main problem with both products is the small window you have. You can imagine if you have symptoms and you still may particularly in wintertime in Europe or in US, you still believe maybe that's a cold. Maybe it's an influenza. Maybe you lose already two days until you go to get a test done. And in some countries you will not get a test done in one day or you need, and then you need to get a prescription. And then if you have the prescription, you need to get the product from the pharmacy. So if you just add one day on all of these steps, then you have done, you are out of the five days already and the product doesn't help you. And that's the major problem for developing countries. How should this work if you are in a rural area? Easy maybe in a city like Nairobi if enough is produced but very difficult for other countries. The next, but there's a real race for antiviral drugs to beat COVID-19. So we will expect many more of these products coming to the market. And there is information that currently 320 medicines in various stages of development. So that's very good news. There is a system in place which is called WHO Solidarity Plus Clinical Trial. This is the idea to repurpose products which are already on the market for other use to test them for COVID-19. And there is a panel in place with experts and they came up that they are now testing three products. The one is artesanate. It's from ICPA, is used for malaria. So it's artesiminin, the product as you know, then it's imatinib is for certain cancers. It's a product from Novartis and there's infliximab and antibody use for diseases of the immune system, particularly in Crohn disease. The repurposing has the big benefit that we know everything about the safety of this product as long as you use it in the same standard dose as it's used for these diseases. You have already manufacturing in place where you can do this and it can be done very cheap and all these companies have agreed if the products show that they work against COVID-19 they will give it to very low prices to the WHO to distribute it to all countries in the world. Currently, this one trial here, the Solidarity Plus Clinic trial is rolled out in 52 countries, many of our countries where we have offices are involved in 600 hospitals, 2000 researchers. So this is really a new and robust approach to evaluate therapeutics which are on the market. The next, there are other initiatives. There's the COVID-19 Therapeutic Accelerator which is funded by Willcome Trust Mastercard by the Gates Foundation, other governments and foundation. And here again is the same idea. Look what is available, look at libraries what pharmaceuticals are available and could be tested. They look mainly from the, it's a little bit like our TASL project, from the very beginning proof of concept until really manufacturing and marketing this product. Therefore, all the important pharmaceutical, international pharmaceutical companies are involved in this and it's a very promising activity. And there's another, there's the largest private public partnership which exists is EME, is the Innovative Medicine Initiative. They have about $3.2 billion from 2014 to 2020 and they will get a similar amount for the next four years. And half of this is paid by Horizon 2020. So it's the European Commission and half is paid by FPA. This is the European Federation for Pharmaceutical Industry Association. So these are all the pharmaceutical industry paying the rest of this, the half of this 3.2 billion. But they started now to work on Horizon on COVID-19 and this is still a low amount, but it's a seed funding and they have decided to have five focus on diagnostics research. So this is the rapid proof of care, a point of care and three new antivirals for the current and future Corona outbreaks. And it's done in all of the European countries with all of the international pharmaceutical industry there and there is very promising the activities going on. My last slide. So what are the conclusion? These two treatments alone aren't likely to close the book on the Corona virus, but there will be a valuable addition to what we have. Most likely not so much in the low and middle income countries, but I think as always, this tracks are further developed and there may be other better solutions in future. But we have the vaccines and now everybody talks about booster shots, particular after the information of this South African new variant. We need more antiviral pills and I've shown there's a lot of initiatives going on. Virus fighting antibodies and we need really some antibodies which are engineered to stick around in people's bodies, not just only a short-term reaction. So it should be a long-acting antibody. That would be very helpful. What we need is fast turnaround testing and sequenced or better say, the rolled regulatory process which proved so nicely in the vaccines. You know, the reason why the vaccines are available after one year was because of the lot of money which was put into this research. And secondly, because the process with the regulatory has changed, there were any information which was available was immediately tested. Normally you have to collect everything and we were going with a lorry full of files to the regulators to start the process. So this takes you at least 10 years and this is different and should be different here as well. Then we need the rapid and really rapid point of care tests good one which are, there's a lot of diagnostic developments going on and I think that's another good news for the future but the most important is we have the non-pharmaceutical interventions in our mask distance, all what we do and need to do continuously and that's clear as always, prevention is better than cure and prevention is definitely cheaper. Thank you. Thank you.